405 Duke Drive, Suite 270 Franklin, TN 37067 T: 855.366.6789

Superior technology and experience ensures that your custom bill review solution from CareWorks Managed Care Services maximizes network penetration and savings.

OPTIMIZING YOUR NETWORK FOR GREATER SAVINGSThe cornerstone of the savings and efficiencies we deliver is PPO Fusion, our network optimization technology. We analyze your claims, bills and geography and match them to our 70+ networks to create an optimized network model. Your claims always start in the network where your best opportunity for savings is available. Also, your data and our networks are updated quarterly to maximize your matrix of networks to deliver the greatest value to your bottom line.

CUSTOM BILL REVIEW SOLUTIONSNetwork penetration and savings are at the heart of our custom bill review solutions, but they are just the beginning. We offer a comprehensive, end-to-end solution that includes:• Service bureau

• A virtual mailroom for bill intake/scanning• KFI/data entry

• Fee schedule and rules application• Multiple levels of auditing• RN complex bill code review

• PPO Fusion Network optimization• Electronic payment issuance

Medical Bill Review

Maximizing network penetration and savings.

CareWorks Managed Care Services

USING OUR APPROACH,YOU RECEIVE THE FOLLOWING

GREATEST DISCOUNTS

GREATEST PENETRATION

FASTEST TURNAROUND

60 - 65% of all bills are caught foroptimized savings.

Penetration rates up to 80% dependingon the jurisdiction.

Most bills returned within48 - 72 hours.

RIGOROUS BILL REVIEWCareWorks’ rigorous bill review starts with the application of the appropriate fee schedule / UCR, and utilization review audits and edits completed by CareWorks Nurse Auditors and Certified Coders to ensure maximum negotiated discounts are applied to each bill. Our experts’ firsthand knowledge of provider billing practices and techniques combined with our processes, innovative technology, robust databases, and unique analysis methodologies enable our Nurse Auditors and Certified Coders to apply rules that prevent overpayment of inappropriate medical charges such as duplicate bills and charges, unbundling, up-coding and medical coding mistakes.

We also negotiate out-of-network bills and have a dedicated team that focuses on large hospital bills to maximize savings and minimize disputes.

Our flexible approach also means that we can apply only the components you need to round out your overall process.

Adjusters and risk managers can easily access, review and approve bills through our Zebra user interface. Zebra’s custom dashboard tool provides full-time transparent communication about what’s happening with your bills and claims, including:• Savings by type/category of bill, state, and network • Calendar view of billing activity on each claim to track

treatment and providers and to understand treatment patterns• Ability to custom filter, sort, and analyze data• Real-time status of every bill in the system• Turn-around time

WE BRING IT ALL TOGETHERAt CareWorks, we start with an effective bill review process. Then we add superior technology, expertise, and innovation to provide a customized and comprehensive bill review solution that:• Simplifies your in-house workflow• Accesses the most efficient and cost-effective networks• Maximizes savings• Pays bills correctly and on time• Communicates efficiently with providers to resolve questions

or disputes • Gives you easy access to all your data for full transparency and

better management

CareWorks Managed Care ServicesMEDICAL BILL REVIEW

cw-mbr-0417

• Multiple, tiered, global and specialty PPO networks• Client and state-specific network• Multiple out-of-network specialty review groups, including

binding out-of-network negotiations• Online adjuster approval of bills

• Flexible auto-approval options

• Private labeling• Time-saving electronic options, including:

• Data capture and indexing• Image and e-bill receipt• Extensive reporting tools• Automated payment capabilities

Our Comprehensive ServicesCareWorks delivers the widest array of services, customizable to fit each client.

About CareWorksCareWorks’ national, custom managed care solutions include bill review, a national PPO network, case management, utilization review, IME, and ancillary services. We leverage technology and data analytics to improve outcomes and deliver superior results for our customers.

CareWorks...Making Managed Care Work.

Get in touchTo learn more about how CareWorks can impact your program, please contact us.

888.350.1150

mbr.sales@careworksmcs.com